1. interRAI Preliminary Screener for Primary Care and Community Care Settings (interRAI Preliminary Screener) Training
Intent: Welcome participants & introduce self. 1

2. Classification: Medium
Agenda
Welcome and Introductions
Part 1: CSS CAP Overview
Part 2: Preliminary Screener Assessment Training
Screener Assessment Overview
Objectives
Coding the Preliminary Screener
Part 3: Assessment and Communication Skills
Part 4: Putting it all together: Role Play and Coding
Wrap-up and Evaluation
Intent of slide: Review Agenda as a four part process.
Resource:
Notes: Participants to Introduce self by name, agency and role. We are doing a more in-depth introduction later in the ASW portion (Community of Knowledge). We will discuss the history of CCIM to connect it to the assessment role that now includes the Screener. We will then explain how the Screener is to be used during initial intake and include instruction on how to manually complete the Urgency Algorithm (in the event you have issues completing it electronically). The goal is for this to be an electronic assessment. This will then be followed up with Assessment Skills training to provide a comfort level with asking personal information over the phone – something that may be new for some participants. Finally, we will complete a check where participants will role play and complete a screener for fictitious clients. Lastly, you will receive an evaluation via survey monkey – we appreciate your feedback.
Housekeeping:
Location of washrooms
Breaks and lunch: will happen at regular intervals where appropriate.
Ask participants to:
Return promptly from breaks
Avoid side bar conversation
Turn cell phone on vibrate
Seek clarity and understanding
Feel free to ask questions 2 2
Classification: Medium 2

3. Workshop Documents Review binder
Intent: Ensure participants know location of the documents in the binder.
Notes: Walk through binder.

4. Part 1: CSS CAP Overview

5. CSS CAP High Level Assessment Process
Client
SCREENER/ INTAKE
ASSESSMENT
PROVIDE SERVICE AND/OR REFER AS APPROPRIATE
COMPREHENSIVE ASSESSMENT
(HC/CHA)
CARE PLAN
SERVICE PLAN
Intent: Visual process from client entry into a CSS HSP to service provision.
Notes: Client receives a intake which may or may not trigger the need for further comprehensive assessment. Follow slide to show flow with and without comprehensive assessment - both lead to service/referral.
Presenter can take opportunity here to mention that:
CCIM is a project funded by the MOH responsible for implementation of the screener and interRAI CHA as well as other common assessment tools implemented: MDS2.0 in LTC, OCAN in MH.
interRAI, who developed the screener, the CHA, the HC and many other interRAI tools, is a collaborative network of researchers in 30+ countries Committed to improving health care for the elderly, frail and disabled. Promotes evidence-based clinical practice by collecting and interpreting high quality data across a variety of health care and social settings.

6. CSS Assessment Type by Client and Program
interRAI CHA
Clients requiring comprehensive assessment to inform care planning – significant ADL/IADL support
Screener
Clients requiring single service for low intensity support
Independent in managing ADL/IADL
interRAI CHA
or Screener
Clients have ADL/IADL needs, caregiver involvement
Need for CHA may be informed by caregiver’s ability to manage
Assessment recipient
HSPs/Programs that may support care plan – client has complete assessment
Intent: Shows which programs use the CHA and/or Screener.
Notes: Walk through slide as presented.
PRC = psychogeriatric resource consultant
SDL = supports for daily living
Types of Program
Adult Day Services, Personal Support /Independence Training, Assisted Living/Supportive Housing (SDL), Attendant Outreach, Case Management/ Care Coordination
Caregiver Support, Crisis Intervention, Overnight Care, Respite
Meals on Wheels, Friendly Visiting, Transportation, Homemaking
Deaf, Deafened and Hard of Hearing Care Services, CNIB
PRC, Aphasia, Home Maintenance, Congregate Dining,
Foot Care

7. What is the interRAI CHA?
interRAI Community Health Assessment (CHA) helps identify adults needing supports to prevent or stabilize early functional or health decline
A standardized comprehensive assessment
Modular format
Not all inclusive – “minimum” data set
Data elements designed to be used for:
Care planning
Quality improvement using quality indicators
Outcome measures based on clinical scales
Intent: as stated on slide.
Notes:
The interRAI CHA tool is a Modular instrument. The core tool has specific assessment items that prompt the assessor to complete supplements
The interRAI CHA is a “Minimum Data Set” and does not include all the information needed for care planning.
Quality Indicators provide the organization [with] an opportunity to look at improvements at an organizational level, whether it is staffing, education or service provision. Quality Indicators will also allow the organization to benchmark with other organizations within their city, LHIN, and provincially
Outcome measurements or scales tell how well the client is doing [by showing] changes as either improvements or declines with each assessment.

8. Core interRAI CHA domains: A-P
*Identification Information
Intake and Initial History
*Cognition
Communication and Vision
*Mood
Psychosocial Well-being
*Functional Status
Continence
Disease Diagnoses
*Health Conditions
Nutritional Status
Medications
Treatments and Procedures
Social Relationships
Environmental Assessment
Discharge
Intent: To provide participants with a link between this tool and the screener (6 screener questions are taken from here).
Resource: CHA tool in reference Tab.
Notes: These are the 16 Domains that clients are assessed with.
Review each a high level with * (same as screener).
On your facilitator copy of the Core and Functional hi-lite the similarities (Identification, Cognition, Mood, Functional Status, Health Conditions & Social Relationships). The purpose is to show the similarities and how much more detailed assessment information is gathered with CHA.
Participants may ask: Why we assess so many domains, when we (HSP org’s) do not provide service to meet the identified needs?
The intent of the interRAI CHA is to facilitate the identification of risk and predict outcomes for clients in the community setting, that lead to service planning and referral (with client’s agreement for the services). Therefore, a comprehensive assessment facilitates gathering the client’s needs as well as strengths and preferences. 8

9. Functional Supplement Domains
Identification Information
Cognition
Mood and Behaviour
Functional Status
Continence
Disease Diagnosis
Health Conditions
Oral and Nutritional Status
Skin Condition
Medications
Treatments and Procedures
Responsibility
*Social Relationships
Environmental Assessment
Discharge Potential
Intent: To provide participants with a link between this tool and the screener (1 screener question are taken from here).
Resource: In reference Tab.
Notes: Review each a high level with * (same as screener).
The domains of the Functional Supplement are similar to the Core CHA. Specific assessment items in the core CHA prompt the assessor to complete the Functional Supplement. This supplement contains an expanded set of assessment items to provide more detailed information than gathered from the Core CHA. Point out that Social Relationships is the only area reflected in Screener.
Adapted with permission from ideas for health, University of Waterloo, June 2010 9

10. Part 2: Preliminary Screener Assessment Training
Intent:
Goal: 10

11. Classification: Medium
Format
Interactive, with time for questions/clarification
Participants are encouraged to:
reflect on their current intake experiences as it relates to assessment
explore how the Preliminary Screener impacts their current business practices
Intent of slide: To give participants a brief outline of how the session will unfold
Resource:
Notes:
Debrief: Questions? 11 11
Classification: Medium 11

12. Classification: Medium
Objectives
Following this section Preliminary Screener Assessors will have increased knowledge in the following areas:
Benefits of the Preliminary Screener
Role of the assessor in the Preliminary Screener process
How to complete the Preliminary Screener
How the screener fits into the overall client assessment process
Intent of slide: To ensure that participant’s understand the objectives for the workshop
Notes: There are many different roles in the room today, but today we are wearing our Assessor hat. An assessor is anyone who gathers relevant information from a client to meet their needs. We all use assessment skill, whether we say they are assessment skills or not.
Debrief: Any questions? 12 12
Classification: Medium 12

13. interRAI Preliminary Screener Overview
interRAI Preliminary Screener will support the intake process guided by the following two main goals:
Enable decision-making related to identifying persons who would likely benefit from a comprehensive assessment
Record basic information about persons who would not be receiving a comprehensive assessment at a later stage
Intent: To provide participants an overview of the Preliminary Screener – this and the next slide.
Some CSS clients are healthy and functionally independent, and not likely to benefit from a comprehensive assessment.
Maintain completed screeners as you would any other client document within your organization that contains PHI. 13

14. Benefits of the interRAI Preliminary Screener
Can be completed over the telephone
Collects essential information needed at time of intake or screening
Informs and supports decisions regarding need for a comprehensive assessment or not
Facilitates inter-agency communication through common assessment language
Standardized, aggregate data can inform evidence-based decision making and planning
Intent of slide: To summarize benefits for client, assessor and organizations.
Notes: facilitates inter-agency communication through common assessment language as we will see that the questions from the screener come from the Core/Functional. Can track which programs clients triggered further assessment more often than others that did not trigger. 14 14
Classification: Medium 14

15. What is the interRAI Preliminary Screener?
Is a rudimentary screener to filter out persons least likely to benefit from undergoing a basic assessment
Is NOT a comprehensive assessment
Only includes the minimum number of assessment items needed to stratify clients into one of two groups:
Those persons who are likely to benefit form a more detailed assessment and,
Those who would not benefit from a more detailed assessment
Should not be used for service planning
Short, simple and quick to complete
Intent of slide: To inform the participants of what the preliminary screener tool is about and remind them of the importance of a therapeutic trusting relationship with the client in order to complete it.
Notes:
Minimum data set needed to stream clients into two groups:
the self-sufficient well-person who would not benefit from a more comprehensive assessment
clients with impairment in any domain or any indication of frailty who would benefit from a more comprehensive assessment 15 15
Classification: Medium 15

16. interRAI Preliminary Screener: Structure
The interRAI Preliminary Screener is designed to be used as a multi-step process involving documentation and decision-making in the following sections:
Identifiers/Demographics
Preliminary Screener – (7 domains)
Cognitive skills, 4 ADLs, dyspnea, self-rated health, unstable condition, self-reported mood, informal helper status
3.Summary
Assessment urgency
Decision re: need for further assessment/interRAI CHA
Intent of slide: To introduce participants to an overview of the preliminary screener that will lead into the next slides where participants will be walked through the preliminary screener and supporting user’s manual.
Notes: in preparation for exploring the preliminary screener ask participants to have ready their copy of the tool and the user’s manual.
Briefly go over the user’s manual:
index page __,
read page __ from last paragraph and 3 bullet points The interRAI Preliminary Screener is designed to…
Page __ participants can read on their own as a referesher
Page __ review the standard format Intent, Definition, Process & Coding (for those completing CHA’s this will be familiar)
Move on to next slide 16 16
Classification: Medium 16

17. Completing the interRAI Preliminary Screener
Section A: Identification Information
Intent - to obtain personal identifiers
necessary to identify the person and link sequential assessments in an electronic
database.
Intent of Slide: Assisting participants to understand and use the tool.
Resource: Users manual.
Notes: Lets get started! Having your interRAI Preliminary Screener User’s Manual open to page 8 and your draft preliminary screener form let’s review Section A where we will be covering the client’s identification information, interpreter need, reason for referral and assessment reference date. Review the intent and coding for all the data elements in section A by using the screener form and reading directly from the user’s manual. REMIND participants about collecting Personal Health Information (PHI) data and need to follow agency privacy guidelines to maintain confidentiality of the client.
Case record number (A4c) will be generated electronically and Facility/agency identifier (A6) is your MIS# (Executive Director or Finance will have).
Emphasize the following example:
A10: Be sure to read the entire definition from page __ of the users manual and emphasize the 24 hour look back period. 17 17
Classification: Medium 17

18. Completing the interRAI Preliminary Screener
Section B: Screener Questions
Contains items used for a decision-making algorithm to differentiate persons who do not require further screening or assessment from those who are likely to benefit from further evaluation.
Cognitive skills for daily decision making
Activities of daily living
Dyspnea
Self-reported health
Instability of conditions
Self-reported mood
Informal helper status
Intent of slide: To inform participants that the responses to the questions in section B will indicate need for further assessment or not.
Resource: Users Manual.
Notes:
B1 -Read the intent from page ___ of the users manual, review a couple of examples from the definition section and discuss the process that includes interviewing the client, observing the client and consulting with others as required. We want to ensure we are coding for what the person is actually doing (performance). Then turn to page ___ and read the 2nd paragraph in totality emphasizing ability vs. opportunity and assessor respecting clients right to make decision we may not agree with. Then review coding.
B2 – Read intent from page ___emphasize that we are not looking at all ADL’s, only 4. Review all 4, emphasize Set-up Help definition (pg. ___) and under Process review helpful questions and stress we are looking at most dependent episode if more than 1 bath over the past 24 hours; and IF they DID NOT have a bath in the last 24 hour period the last bath they had would apply. There are ADL vignette examples on page ___ if required. Review coding.
B3 – Read the intent from page 18 of the users manual, from Process section use other expressions i.e. “winded”, “unable to catch your breath” etc. and review coding emphasizing that IF the activity did not occur over the past 24 hours but would have had the person undertaken activity than code according to that episode. There are vignettes on page ___.
B4 – Read the intent from page ___ and the process emphasizing this is strictly self-reported and point on coding option #8 when reviewing coding. There are vignettes on page ___.
B5 – Read the intent and definitions from page ___ of the users manual. Emphasize the difference between B5A (conditions/disease make cognitive, ADL, mood or behaviour patterns unstable) and B5b (acute episode or flare up of recurrent or chronic problem).
B6 – Read the intent from page ___ of the users manual, and emphasize this is a “self-reported” question just as B4. Review coding and not there are vignettes on page __.
B7 – Read the intent from page ___of the users manual and make sure to ask questions 7a (informal helper) and 7b (family/close friends) separate from the client being assessed. Sensitivity is important here as is looking at the current situation and ability to continue into the future. There is a vignette on page ___. 18 18
Classification: Medium 18

19. Assessment Urgency Algorithm v219
Assessment Urgency Algorithm v2
interRAI Preliminary Screener for Primary Care and Community Care Settings© v1
Intent: To provide a simple high level overview before moving on to explaining detail in next slide on how to calculate the AUA.
Notes:
Tool generates the outcome through your software
Trigger threshold is a “3” – any score of 3 or higher indicates client would benefit from further comprehensive assessment
The benefit of this algorithm is that it shows potential level of risk client could be at
As an assessor you may want to have further conversation with the client about other supports they may need or benefit from
Move to next slide to go through details of how we calculate the score using the manual. 19

20. Completing the interRAI Preliminary Screener
Section C: Summary
Intent: to record the computer-generated algorithm score (that is embedded in the interRAI Preliminary Screener) so that it may be used to inform decisions related to assessment urgency.
Intent of slide: To introduce participants to the coding algorithm that they will have to complete “manually” for this training. Let them know this will be automatically generated when they use the computer.
Resource: Assessment Urgency Algorithm (Decision Support Tool) as visual and Sample Completed Preliminary Screener.
Notes: Read from page ___ of the users manual the definition and point out the Decision-support Algorithm summarizes the questions to inform decision making while the Assessment Urgency Algorithm (the score they will transcribe into C1) indicates the need for further assessment (3 or higher) or not (1 or 2). Review coding 1 (least urgent) & 6 (most urgent) for comprehensive assessment.
Using the interRAI Assessment Urgency Algorithm (Decision Support Tool) & Sample Completed Preliminary Screener walk through starting with the Self-reliance Index that shows:
Impairment if any answer in Questions B 1 (Cognitive Skills for Daily Decision Making) or B 2 (ADL’s) has a response of yes.
Modified independent or any impairment in Cognitive Skills for Daily Decision Making (B1 = 1)
Received supervision or any physical help in ANY one or more assessed ADL:
Bathing (B2a = 1), Personal hygiene (B2b = 1), Dressing lower body (B2c = 1), Locomotion (B2d = 1)
Then move down through the tool explaining each step along the way using Mr. Bob Smith.
Then, using hypothetical client Mrs. Smith go through the assumption that she is self-reliant and ends with a 3 under Unstable Condition using Arthritis as exacerbation.
Other Considerations:
Read from manual page ___Section C Summary C1 Process 2nd paragraph.
Always err on the side of caution. 20 20
Classification: Medium 20

21. Classification: Medium
Q&A / Evaluations
Notes: Remind participants they will receive survey monkey evaluation. 21 21
Classification: Medium 21

22. Thank you! Project Support Centre
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